Ha Kee Soo, Choi Jae Young, Jung Se Yong, Kim Jung-Sun, Byun Ki Hyun, Akagi Teiji, Zufarov Mirjamol M
Department of Pediatrics, College of Medicine, Korea University, Seoul, Republic of Korea.
Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Interv Cardiol. 2018 Oct;31(5):685-692. doi: 10.1111/joic.12513. Epub 2018 Apr 25.
Device embolization is the most frequent procedural complication during transcatheter closure of congenital cardiac defects. Retrieval of an embolized device may often be complicated by failure to introduce the right atrial (RA) disk hub into the sheath or difficulty in securely grasping the hub pin of RA disk. We aimed to evaluate the efficiency and success rate of device retrieval using a novel double snare technique.
We reviewed retrieval procedures of embolized atrial septal defect (ASD) or left atrial appendage (LAA) occluder using double snare technique reported from five tertiary referral centers in Korea, Japan, and Uzbekistan. A total of 16 retrieval procedures in 15 patients were reported, including 14 patients who were planned for ASD device closure while 1 patient was planned for LA appendage occlusion.
Retrieved devices included 15 ASD occluders from six different manufacturers and one Amplantzer cardiac plug. Success rate of retrieval procedure was 100% using the double snare technique. There were no complications related to device retrieval. Most (15/16, 93.8%) of these devices could be retrieved through their original delivery sheaths. In six patients for whom retrieval was unsuccessful with conventional single snare technique and switched to double snare technique, the retrieval time was shortened significantly (P = 0.004*) by using the double snare technique.
The double snare technique enables effective retrieval of various embolized devices. It abolishes the need of changing the sheath to a larger one in most patients.
在经导管封堵先天性心脏缺损过程中，装置栓塞是最常见的手术并发症。取出栓塞装置时，常常会因无法将右心房（RA）盘毂插入鞘管或难以牢固抓住RA盘的毂销而变得复杂。我们旨在评估使用新型双圈套技术取出装置的效率和成功率。
我们回顾了韩国、日本和乌兹别克斯坦五个三级转诊中心报告的使用双圈套技术取出栓塞房间隔缺损（ASD）或左心耳（LAA）封堵器的手术过程。共报告了15例患者的16次取出手术，其中14例计划进行ASD装置封堵，1例计划进行左心耳封堵。
取出的装置包括来自六个不同制造商的15个ASD封堵器和一个Amplatzer心脏封堵器。使用双圈套技术取出手术的成功率为100%。没有与装置取出相关的并发症。这些装置中的大多数（15/16，93.8%）可以通过其原来的输送鞘管取出。在6例使用传统单圈套技术取出失败并改用双圈套技术的患者中，使用双圈套技术后取出时间显著缩短（P = 0.004*）。
双圈套技术能够有效取出各种栓塞装置。在大多数患者中，无需更换为更大的鞘管。
